Notice: This CMS-approved document has been submitted - Philips ...
Notice: This CMS-approved document has been submitted - Philips ... Notice: This CMS-approved document has been submitted - Philips ...
CMS-1403-FC Update), physician pay for reporting (the Physician Quality Reporting Initiative), home health pay for reporting, the Hospital VBP Plan Report to Congress, and various VBP demonstration programs across payment settings, including the Premier Hospital Quality Incentive Demonstration and the Physician Group Practice Demonstration. The preventable hospital-acquired conditions (HAC) payment provision for IPPS hospitals is another of our value-based purchasing initiatives. The principle behind the HAC payment provision (Medicare will not provide additional payments to IPPS hospitals to treat certain preventable conditions acquired during a beneficiary’s IPPS hospital stay) could be applied to the Medicare payment systems for other settings of care. Section 1886(d)(4)(D) of the Act requires the Secretary to select for the HAC IPPS payment provision conditions that are: (1) high cost, high volume, or both; (2) assigned to a higher paying Medicare Severity-Diagnosis Related Group (MS-DRG) when present as a secondary diagnosis; and (3) could reasonably have been prevented through the application of evidence- based guidelines. Beginning October 1, 2008, Medicare can no longer assign an inpatient hospital discharge to a higher paying MS-DRG if a selected HAC was not present, or could not be identified based on clinical judgment, on 196
CMS-1403-FC admission. That is, the case will be paid as though the secondary diagnosis related to the HAC was not present. Medicare will continue to assign a discharge to a higher paying Medicare Severity-Diagnosis Related Group (MS-DRG) if a selected condition was present on admission. The broad principle articulated in the HAC payment provision for IPPS hospitals (that is, Medicare not paying more for certain reasonably preventable hospital-acquired conditions) could potentially be applied to other Medicare payment systems for conditions that occur in settings other than IPPS hospitals. Other possible settings of care include, but are not limited to: hospital outpatient departments, ambulatory surgical centers, SNFs, HHAs, ESRD facilities, and physician practices. Implementation would be different for each setting, as each payment system is different and the level of reasonable prevention through the application of evidence-based guidelines would vary for candidate conditions across different settings of care. However, alignment of incentives across settings of care is an important goal for all of our VBP initiatives, including the HAC payment provision. A related application of the broad principle behind the HAC payment provision for IPPS hospitals could be considered through Medicare secondary payer policy by 197
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<strong>CMS</strong>-1403-FC<br />
Update), physician pay for reporting (the Physician Quality<br />
Reporting Initiative), home health pay for reporting, the<br />
Hospital VBP Plan Report to Congress, and various VBP<br />
demonstration programs across payment settings, including<br />
the Premier Hospital Quality Incentive Demonstration and<br />
the Physician Group Practice Demonstration.<br />
The preventable hospital-acquired conditions (HAC)<br />
payment provision for IPPS hospitals is another of our<br />
value-based purc<strong>has</strong>ing initiatives. The principle behind<br />
the HAC payment provision (Medicare will not provide<br />
additional payments to IPPS hospitals to treat certain<br />
preventable conditions acquired during a beneficiary’s IPPS<br />
hospital stay) could be applied to the Medicare payment<br />
systems for other settings of care. Section 1886(d)(4)(D)<br />
of the Act requires the Secretary to select for the HAC<br />
IPPS payment provision conditions that are: (1) high cost,<br />
high volume, or both; (2) assigned to a higher paying<br />
Medicare Severity-Diagnosis Related Group (MS-DRG) when<br />
present as a secondary diagnosis; and (3) could reasonably<br />
have <strong>been</strong> prevented through the application of evidence-<br />
based guidelines. Beginning October 1, 2008, Medicare can<br />
no longer assign an inpatient hospital discharge to a<br />
higher paying MS-DRG if a selected HAC was not present, or<br />
could not be identified based on clinical judgment, on<br />
196